The importance of parathyroid hormone and vitamin D status in the treatment of osteoporosis and renal insufficiency.

Suboptimal vitamin D status is common in sick, elderly patients and is associated with secondary hyperparathyroidism, increased bone turnover, and accelerated bone loss. Nutritional supplementation of elderly patients with vitamin D and calcium has been associated with a reduction in fractures and falls. Recently, the National Kidney Foundation (NKF) recommended screening parathyroid hormone (PTH) levels in those with glomerular filtration rates (GFR) less than 60 mL/min. The PTH target range increases as renal failure progresses because of skeletal resistance. When PTH levels are above the target range, measurement of serum 25-hydroxyvitamin D (25-OH-D) is recommended. If the 25-OH-D level is less than 30 ng/mL, supplementation with vitamin D is recommended. Practitioners should consider supplementing most residents with vitamin D and calcium or follow NKF guidelines.